Provider Demographics
NPI:1720611940
Name:ODISH, AMANDA (LMFT)
Entity type:Individual
Prefix:
First Name:AMANDA
Middle Name:
Last Name:ODISH
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16-566 KEAAU PAHOA RD # 188-397
Mailing Address - Street 2:
Mailing Address - City:KEAAU
Mailing Address - State:HI
Mailing Address - Zip Code:96749-8137
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:16-2001 UAU ROAD
Practice Address - Street 2:
Practice Address - City:MOUNTAIN VIEW
Practice Address - State:HI
Practice Address - Zip Code:96771-1111
Practice Address - Country:US
Practice Address - Phone:808-481-9303
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-02-17
Last Update Date:2022-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101Y00000X
HIMFT-785106H00000X
HI106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101Y00000XBehavioral Health & Social Service ProvidersCounselor